Open Enrollment Reminders

HIPAA

Final HIPAA nondiscrimination and wellness programs rules were published on February 12, 2007 and effective July 1, 2007.

A lot of attention has been focused on the portion of the new rules covering wellness plans and many companies without wellness plans may assume they are in the clear. However, nondiscrimination rules apply to any company sponsored health insurance plan.

Employers need to be careful that types of medical care not covered by the insurance policy do not discriminate against a set of workers.  For example, a company could not stop coverage for insulin in its health plan because that could be interpreted as the company does not want employees with diabetes.  The area, most often under the microscope, is exclusions for coverage of prescription contraceptives like the birth control pill.  If an insurance plan does not cover prescription birth control pills, but does cover other kinds of contraception, such as vasectomies, courts in some cases have found those policies to be discriminatory against women. 

Click here for complete text of final rules.

WHCRA

The Women’s Health and Cancer Rights Act (WHCRA) is a federal law that provides protection for patients who elect breast reconstruction or certain other follow-up care in connection with a mastectomy.  This law applies to both persons covered under group health plans and persons with individual health coverage.  WHCRA does not require health plans to pay for mastectomies.  If a group health plan chooses to cover mastectomies, then the plan is generally subject to WHCRA requirements.

The law requires group health plans and health insurance issuers, including insurance companies and health maintenance organizations (HMOs), to notify individuals regarding coverage required under the law.  Notification is required at two separate times: upon enrollment and annually. 

Employers should make sure their health insurance companies are complying with this law.

Medicare Part D

Employers who currently provide prescription drug coverage must notify all members eligible for Medicare as to whether the employer coverage is creditable prescription drug coverage.  The purpose of this notice is to help Medicare beneficiaries understand whether they will need to enroll in a Part D plan during the initial enrollment period or whether they can maintain their existing coverage and avoid a late enrollment penalty should they decide to enroll in Part D at a later date.  Employers must provide this notice of their annual enrollment period or November 15, whichever is later). Employers must also provide a disclosure of creditable coverage status to CMS on an annual basis. 

Please note, the member notice must be provided to all members, which includes the spouses of employees.  While the employee may not be eligible for Medicare, the spouse may be.  It is better to send the notice to all employees via mail, to ensure Medicare eligible spouse’s receive the notice rather than be penalized for not providing the notice to all members.

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